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NPI Code Detail

MEDICARE: MARTA JEAN WAYT DO

MEDICARE:   MARTA JEAN WAYT  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician1541TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1TN01R2OTHERTNJOHN DEERE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
34066478OTHERTNBCBS

General Provider Information

NPI Number : 1316903099
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTA JEAN WAYT DO
Provider Business Mailing Address
First Line : 1021 W OAKLAND AVE STE 310
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-2192
Country : US
Telephone Number : 423-952-2111
Fax Number :
Provider Business Practice Location Address
First Line : 111 W STONE DR STE 200
Second Line :
City : KINGSPORT
State : TN
Zip : 37660-6028
Country : US
Telephone Number : 423-723-2030
Fax Number : 423-247-4110
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2006
Last Update Date : 01/26/2026

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Directions to “ MARTA JEAN WAYT DO” Practice Location

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